PET scan stress test

H

Heart test anon

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67 year old healthy male, never any issues getting the Class 3. Just signed up for Medicare, so the PCP wanted to get a cardiac work up just to “get a baseline”.

EKG and echocardiogram normal. Venous ultrasound normal. Blood labs normal.
Carotid US showed minor plaque.

The PET chemical stress test showed mild pressure elevation in left pulmonary artery and minor “damage to part of the lower heart muscle.” (Is how the cardiologist put it). He said no treatment is needed, just follow up every 6 months to make sure it’s not progressing. He seemed to indicate these results aren’t unusual for someone in their 60s.

At the next renewal, can the AME issue or will it be deferred and if so what will the FAA want?
 
A seated chemical stress is only recognized by FAA if you have a doctor- documented orthopedic reason why you cannot run. Why? Chemical stress NEVER gets you to 905 of V Max heart rate, which for you is Hear Rate 138.

The FAA requirement is the aforementioned 9 minute running Bruce Stress test
All the tracings
Current to application Fasting glucose and lipids
Cardiologist's current assessment of your CAD risk factor reduction efforts.

This has to be deferred, first time. the Inferior wall is not working so you have the diagnosis of coronary disease....PS the ejection fraction has to be >40%.
 
The description of the inferior wall not moving means that it has been infarcted. that means Section 2307. (e)1(C)(i). No Bueno.
 
Curious to see what real reason for the more advanced testing is- stress test namely. If I order these tests there is a short list of approved diagnoses to get Medicare to cover. Medicare does not cover “let’s get a baseline”. Especially something more advanced like PET imaging. Inferior wall abnormalities are commonly false
Positive findings as it is the most difficult part to image- especially on overweight individuals.
Echocardiograms show wall motion abnormalities-you Sid that was normal so unlikely previous infarction.
Stress tests will show are of heart not getting proper blood flow. You need to elucidate if that area showed a reversible defect or a fixed. Reversible equals partial blockage-go for Cath. Fixed defect equals no blood flow meaning previous infarct or again false positive- due to overweight (tissue attenuation).
But “let’s get a baseline” is not a diagnosis. If that’s truly why you and they ordered it and you were having no problems then tough noogies- in medicine when you start snooping around for things jus to look for no reason it often gets more expensive and can have a lot of unintended consequences.
 
Only signed up for Part A Medicare and still have private insurance for a few more months. They paid, so I need to find out what diagnosis code if any was used and get a copy of the results.

6’1” and 180 pounds, don’t know if that’s overweight enough to cause a false positive. Extra weight carried around belly. No orthopedic limitations, very active, walk 6-7 miles a day at work climb 7 flights of stairs a day, don’t know why they did this instead of the treadmill.

If the cardiologist can say “You have had NO infarction,” then I can go BasicMed now, seems to be the case. Per Dr. Chien post #4 it’s the evidence of infarct that is the problem. But I cannot go BasicMed now unless the cardiologist can say that; it might require more tests. If the cardiologist cannot make that statement then I ask him to do the Bruce protocol (even if I pay out of pocket) and gather what Dr. Chien lists in post #2, go to the AME and expect deferral.

This is exactly what I needed, thank you all for your fast and helpful responses.
 
Heart test anon said:
Only signed up for Part A Medicare and still have private insurance for a few more months. They paid, so I need to find out what diagnosis code if any was used and get a copy of the results.

6’1” and 180 pounds, don’t know if that’s overweight enough to cause a false positive. Extra weight carried around belly. No orthopedic limitations, very active, walk 6-7 miles a day at work climb 7 flights of stairs a day, don’t know why they did this instead of the treadmill.

If the cardiologist can say “You have had NO infarction,” then I can go BasicMed now, seems to be the case. Per Dr. Chien post #4 it’s the evidence of infarct that is the problem. But I cannot go BasicMed now unless the cardiologist can say that; it might require more tests. If the cardiologist cannot make that statement then I ask him to do the Bruce protocol (even if I pay out of pocket) and gather what Dr. Chien lists in post #2, go to the AME and expect deferral.

This is exactly what I needed, thank you all for your fast and helpful responses.
Click to expand...
Most private insurances typically follow the Medicare guidelines for diagnoses approved for tests. Especially cardiac testing
 
Heart test anon said:
I ask him to do the Bruce protocol (even if I pay out of pocket) and gather what Dr. Chien lists in post #2, go to the AME and expect deferral.
Click to expand...

I'd hire Bruce if you have any reservations whatsoever concerning your present AME, he helped me through the minefield after an AVR.
 
Heart test anon said:
If the cardiologist can say “You have had NO infarction,” then I can go BasicMed now, seems to be the case. Per Dr. Chien post #4 it’s the evidence of infarct that is the problem. But I cannot go BasicMed now unless the cardiologist can say that; it might require more tests. If the cardiologist cannot make that statement then I ask him to do the Bruce protocol (even if I pay out of pocket) and gather what Dr. Chien lists in post #2, go to the AME and expect deferral.
Click to expand...
This is backwards. Unless the cardiologist is diagnosing you with a previous MI, you are eligible for Basic Med with no SI. You do not have to prove you've never had an MI to be eligible. From the horse's mouth:

  • A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
    • Myocardial infarction;
    • Coronary heart disease that has required treatment;
    • Cardiac valve replacement; or
    • Heart replacement.
Click to expand...

https://www.faa.gov/licenses_certificates/airmen_certification/basic_med/
 
Doesn’t matter as to the order. If you primary is dumb enough to give you a basic, the moment the cardiologist sez CAD/ infarction, the basic is no good.

so you have to do per the 8:08 AM post, anyways....
 
Dry Creek said:
My vote goes for Basic Med too.
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The only way you get focal cardiac wall dysfunction is coronary disease, fellas....wall death and scarring. You can hope-hope-hope all you want but it doesn’t “just go away”.

the object lesson is, don’t do unnecessary tests.....
 
bbchien said:
If you primary is dumb enough to give you a basic, the moment the cardiologist sez CAD/ infarction, the basic is no good.
Click to expand...

[sarcasm]
Nothing says his Primary has to do the Basic exam. What if he got his cardiologist to do it? :)
[/sarcasm]
 
LOL. Lesse. Vision testing, color testing.....urine testing.....there are a few others......
 
bbchien said:
Doesn’t matter as to the order. If you primary is dumb enough to give you a basic, the moment the cardiologist sez CAD/ infarction, the basic is no good.
Click to expand...
Indeed, if a doctor who's actually examined him diagnoses an MI or coronary heart disease requiring treatment, basic med will be off the table. But if that hasn't happened, it's not correct that the cardiologist has to definitely state, "No MI."
 
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